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IN MALAYSIA, pain management is still in its infancy, although pain medicine has been developed over the last 20 years or so, says Dr Mary Suma Cardosa, consultant anaesthesiologist and pain management specialist at the Selayang Hospital in Kuala Lumpur. At the moment there are less than a dozen pain clinics in the country.

“There are different types of pain clinics,” explains Dr Cardosa. “Some concentrate on medication. But nowadays a lot more are multi-disciplinary pain clinics, where you have a physiotherapist, psychologist, occupational therapist, social worker, as well as the doctor, all involved in the management of the patient.”

She says during her time in medical school, students were never taught about chronic pain. Thus the level of awareness is still low among not just lay people, but also doctors.

Movement:
Chronic pain
sufferers
need to
exercise
regularly.

“What we are trying to do at the Malaysian Association for the Study of Pain, is run workshops for general practitioners and doctors in other specialties, to talk to them about the concept of chronic pain, where pain is a disease and not a symptom.”

At the Selayang Hospital pain clinic, Dr Cardosa and her staff run a two-week pain management programme in which patients participate in groups of 10. They are taught how to manage their pain, not eliminate it.

Previously, people only understood chronic pain from the biomedical point of view, so the psychological and social contexts were not taken into account.

Dr Mary Suma Cardosa

“Sometimes the people around the patient can reinforce the disability that has already developed in the patient,” says Dr Cardosa.

“We struggle against that all the time. We work with the patients and they get better, and start doing more. When they go back to their original doctor, the first question he/she will ask them is, ‘How’s your pain?’ And they will answer, ‘It’s still there.’ So this doctor will think the pain clinic is useless. Our aim is not to get rid of the pain, but to help the patient feel better and do more.”

She related the experience of one of her patients whose arm was paralysed after a motorcycle accident. He lost his job, was angry with his wife, who was working, and he had to look after the children. He tried all sorts of medication and even went to India. Then he came to Dr Cardosa’s clinic and learned how to manage his pain.

When he met the surgeon who treated his arm, the first thing the surgeon asked him was, “How is your pain?“ The patient later complained to Dr Cardosa that the surgeon shouldn’t have asked him about his pain, but about how he was.

“So if the patient were clever, she or he would know what is important,” says Dr Cardosa. “To that patient, even though his pain is still there, he is much better. Eventually, he went back to work and has really done well. But if you ask him about his pain, he would say it is seven on a scale of 10. And that is severe pain. But it doesn't worry him.”